Healthcare Provider Details

I. General information

NPI: 1720504814
Provider Name (Legal Business Name): LAZOS RADIOLOGY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 08/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 CALLE MANUEL PAVIA PAVIA MEDICAL PLAZA, SUITE 113
SAN JUAN PR
00910
US

IV. Provider business mailing address

PO BOX 11792
SAN JUAN PR
00910-2892
US

V. Phone/Fax

Practice location:
  • Phone: 787-727-0500
  • Fax: 787-268-5511
Mailing address:
  • Phone: 787-727-0500
  • Fax: 787-268-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471B0102X
TaxonomyBone Densitometry Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2471N0900X
TaxonomyNuclear Medicine Technology Radiologic Technologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code2471M2300X
TaxonomyMammography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. WILMA CORDERO GINES
Title or Position: MANAGER
Credential:
Phone: 787-727-0500